Grace Notes: The Night I Buried Gabriella
Recently I was explaining to a young woman why I recommended that she seek hospice care. I explained that additional chemotherapy would not prolong her life and that there were significant risks and burdens. I paused and then asked if what I had said made sense. She nodded, “You’re telling me I’m dying.” Then she asked, “Why is God punishing me?” I immediately assured her it was nothing she did. I heard myself ramble on about why people develop lymphoma and why some lymphomas resist the effects of chemotherapy. As she turned her head away, I sensed a growing distance between us.
Physicians are said to pull away from people who are dying because we view death as failure. I favor an alternative explanation: we are unprepared for the intimacy required to care for a dying person. I am not insensitive to the personal challenges that confront a person with a life-threatening illness in my work as a leukemia specialist. But my relationship with the ill person is largely framed within the context of my medical expertise. And the activities of diagnosis and treatment necessary for recovery create—or allow me to maintain—a comfortable distance; at least initially.
But a dying person is in a profoundly different place. While medical expertise is not unimportant, it is frequently not relevant. If I am not mindful of this and I fail to demonstrate a willingness to shift my attention, then I inadvertently drift further away. Or to put it in a slightly different way, I need to make a deliberate commitment to draw closer to the person. As I reflect on the challenges of this commitment, I am drawn to what I learned the night I buried Gabriella.
I had buried many animals in my garden, mostly chipmunks killed by our cats. But the burial of Gabriella was more complicated. After steadfastly refusing to have a pet for years, our friend Julie had promptly fallen in love with the two kittens she agreed to provide a temporary home. Gabriella, the more adventuresome, had been struck by a car earlier that day.
It was a cool autumn night. The moon was a bright disc dissolving into the clouds on the southern horizon. Julie and my daughter Millicent—who was nine years old—had declined to join me after I dug the grave.
Returning to the darkness of my garden, I was aware of moving away from Millicent and her grief. I wanted to reassure Millicent. But, in the house, I had struggled to find the right words. So I retreated into the measured, purposeful, and necessary activities required to bury Gabriella.
And that is the lesson I learn over and over again. If I am not careful I continue the purposeful activities of medical care well past their relevance. I mistake action for reassurance.
I do not believe so-called medical miracles are the acts of a generous God. Nor do I believe human illness is the act of a vengeful God. It doesn’t matter, however, what I believe. What matters is I remain attentive and close enough for the dying person to ask the questions they want to ask; questions for which I am not expected to have the answer.
The only reassurance I can provide people who are dying person is that I will remain close enough to listen, that I will not abandon them.
Dr. Larry Cripe is the medical director for palliative care at University Hospital in Indianapolis.